The Association Between Sleep Duration and Clinical Measures of Concussion at Baseline and Postinjury in the United States Service Academy Cadets and Midshipmen

The purpose of this study was to examine the relationship between sleep duration and clinical concussion assessments across concussion management timepoints in service academy cadets and midshipmen. An observational cohort study was conducted at four military service academies participating in the Concussion Assessment, Research and Education Consortium from 2014-2020. Demographic information (site, academic year, varsity status, sex, and concussion history) and pre-injury baseline assessments were collected at the time of enrollment. Participants who sustained a concussion underwent standardized evaluations at three follow-up timepoints [initial, graduated return to activity protocol initiation (GRTA), unrestricted return to activity (URTA)]. The Sport Concussion Assessment Tool was used to assess concussion symptom burden, cognitive function and balance and the Brief Symptom Inventory-18 was used to assess psychological distress at each timepoint. Self-reported hours slept was recorded during each evaluation. Univariate and multiple linear regression models were used to examine the relationship between sleep duration and clinical assessments. Kruskal-Wallis models were used to evaluate differences in clinical assessment outcomes by hours slept. During the study period, 17,194 participants (25% female;19.01 ± 1.41y) completed a baseline assessment and 1,534 (39% female;20.02 ± 1.49y) sustained a concussion. Linear regression models revealed sleep duration was associated with symptom severity scores across all evaluation timepoints: baseline (Coefficient = −2.22; 95% CI = −2.36, −2.07; p = <0.001), initial (Coefficient = −2.64; 95% CI = −3.27, −2.00; p = <0.001), GRTA (Coefficient = −0.30; 95% CI = −0.40, −0.20; p = <0.001), and URTA (Coefficient = −0.14; 95% CI = −0.19, −0.09; p = <0.001). Similar results were observed for psychological distress, balance and cognitive assessments with increased sleep associated with improved outcomes. Increased sleep may be associated with improved clinical assessment outcomes and should be considered when evaluating these assessments.